A bipartisan group of senators is pushing the CMS to begin measurement of a program designed to cut billions of dollars in annual waste and fraud from Medicare.
Senators look for metrics on fraud analytics program
Sen. Tom Carper (D-Del.), chairman of the Senate Homeland Security and Government Affairs Subcommittee on Federal Financial Management, and Sens. Scott Brown (R-Mass.) and Tom Coburn (R-Okla.) wrote Dr. Peter Budetti, deputy administrator and director of CMS' Center for Program Integrity, on Tuesday to urge measurement of a predictive modeling program aimed at preventing payments to suspect providers and suppliers.
"We believe it should be a top priority of the Centers for Medicare and Medicaid Services to ensure taxpayer dollars are not used to pay providers or suppliers in the Medicare program who are engaged in fraudulent schemes or criminal activities," they wrote. "We believe the correct implementation of predictive analytics technology could be an important step forward in saving taxpayer dollars."
In July, the CMS deployed predictive analytics technology to review all of the Medicare fee-for-service claims, as required by the Small Business Jobs Act of 2010. However, it is "impossible" to measure the effectiveness of the technology without sufficient metrics and processes, the senators wrote. The agency was unsure when it would establish such tracking measures, Budetti told the panel in July.
The senators noted that as recently as fiscal 2010, Medicare made nearly $48 billion in improper payments.
"Moreover, we are also concerned that there is not yet in place complete strategies, procedures and staffing for appropriately investigating, stopping and otherwise responding to potential or actual identified improper payments and fraud," the senators wrote.
A CMS spokesman did not respond immediately to a request to comment on the senators' query, including whether the CMS has excluded any providers or suppliers from Medicare based on its predictive analytics technologies.
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